Take precautions before undergoing a colonoscopy
It’s usually safe to have screening while taking blood thinners
Dear Doctor: I am currently taking 20 mg of Xarelto daily, and have a screening colonoscopy scheduled soon. The preparation instructions said not to stop taking blood thinners, but didn’t specifically mention Xarelto. I contacted the office and spoke with a scheduler, who said those instructions applied to all blood thinners.
Previously, I was told that I would need to go off of blood thinners for five days prior to a colonoscopy.
Since this was a contradiction to the instructions from the clinic, I have tried to reach out to other medical sources to see if I could get a consensus on what to do, but no one has responded to me yet.
There is a strong history of clotting problems in my family. Would you weigh in on this matter?
The last time I had a screening colonoscopy was around 2005, and there weren’t any issues.
I realize this is a scope and not surgery, but it has me concerned enough that I am considering putting this off until I can get a satisfactory response. — B.R.
A Most screening colonoscopies now are done with patients still on their anticoagulants, although for patients on warfarin (Coumadin), it is preferred for levels to be on the low end of the therapeutic range.
This is a standard recommendation by the American Society of Gastrointestinal Endoscopy.
The situation would be different for a high-risk endoscopic procedure, such as removing a large polyp.
I have had to deal with this situation many times in my practice, and most often, all anticoagulants are stopped then restarted after the colonoscopy. There are some people who are at such high risk for clots that we use injection medications to prevent blood clots until the night before the procedure, but that is normally reserved for the
highest risk of all. It’s a judgment call as to whether to use the injection anticoagulants to prevent clots around the colonoscopy.
Dear Doctor: Could you have a column about sexually active elderly women (80s), and also touch on the subject of orgasm headaches? I don’t want to risk explaining something to my family, and I am embarrassed to mention it to my doctor. — Anon.
A Headaches associated with orgasm are rare, but not as rare as you might think.
They happen more often in men than in women, and can be associated with structural problems in the brain. Because of this last point, every person with headache that occurs during sexual activity or orgasm should have an evaluation, such as a CT or MRI scan. So, you will need to overcome any embarrassment and see your doctor. It is not common, but people have had strokes associated with this type of headache.
If the evaluation shows no structural problems in the brain, there are effective treatments that can be taken before sexual activity to prevent a headache.
As far as other comments on sexual activity in the elderly, many healthy couples continue to be sexually active into their 80s and beyond. Risk of sexually transmitted infections is low, but not zero.
I’ve discussed how many medical conditions affect sexual function in both men and women, and often the goal is to improve overall sexual health for the couple.